Internal Medicine

Principles of Learning

Principles of Learning


Our learning programmes are based on the principles of active, experiential, self-directed adult learning. These terms are not just pretty phrases, but have a specific meaning.

The following paragraphs provide a brief overview of some of the concepts of learning theory that we believe should be addressed in the programmes offered by the Division of Medicine. Thereafter the terms active, experiential, self-directed and adult are explained.

Each section is linked to a further page which covers that aspect in more detail.

Learning Theory

Students and teachers frequently operate on the assumption that learning merely comprises storing facts somewhere in the brain. This can be thought of as analogous to opening the top of the head and pouring knowledge in until it overflows. This is hopelessly inadequate as a model for teaching and learning, particularly in clinical medicine.

Fact Pouring

Composite image of these souces 1,2,3

It is important therefore that the clinical educator has a clear grasp of the concept that expertise in clinical medicine is not predicated on rote memorisation, or the ability to reproduce factual knowledge, but on the ability to conceptualise complex, relational patterns of information which together constitute a workable substrate on which to base the essential clinical tasks of recognition, diagnosis, investigation, management, prognosis and effective communication.

Summarised briefly below are some aspects of learning theory which we have found helpful to an understanding of what it is that we require of our students. Each item can be followed to a page in which it is covered in more detail: these can be accessed individually from our menu as well.

Schema Theory

Schema theory specifically addresses the mechanisms whereby we actively make meaning of information. A schema is a mental structure for representing generic concepts stored in memory – a framework, plan, or script.

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SOLO Taxonomy

The SOLO (structured observed learning outcomes) taxonomy describes five level of increasing complexity in a student’s understanding of a subject. Essentially these relate to the student’s increasing recognition and utilisation of the relationships between the elements of knowledge, rather than mere focusing on, and recalling, the elements themselves.

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Blooms Taxonomy

A group of educational psychologists led by Benjamin Bloom classified the thinking behaviours which underlie learning in 1956. They listed these under three major headings: the cognitive (knowledge), affective (attitudinal) and psychomotor (skills-based) domains. This work was completed in 1956. Today it principally consulted for its treatment of the cognitive domain which is used.

The diagram below illustrates a modified version of the Bloom’s hierarchy of cognitive behaviour, and highlights the importance of moving off the memorising/recall basis and addressing the higher levels in learning, teaching and assessing: understanding, application, analysis, evaluation and creativity. 

Blooms Hierachy
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Deep and Surface Learning

An important divide is that between deep and surface learning. The deep learner is self-motivated to learn in order to master a subject, and probes beneath the facts for the underlying structure and relationships. The surface learner by contrast tends to concentrate on accumulating factual knowledge for its own sake, without a real concept of the underlying structure, and is often externally motivated, e.g. by the need to pass assessments.

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Principal modes of learning applicable to clinical medicine

Experiential Learning

Experiential learning is a powerful learning tool in clinical medicine. For registrar training, it is by far the most important learning methodology employed. For undergraduate students, it is widely understood by teachers as essential, though often not explicitly recognised for what it is. It is frequently labeled “practice” or “seeing patients” when in fact it is one of the most powerful drivers of new learning – the accumulation of new knowledge – known.

Experiential learning is primarily significant in its emphasis on personal involvement and personal acquisition of knowledge and skills through relevant experiences.

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Self-Directed Learning

Adapted from Lowry CM

Self-directed learning has been described as a process in which individuals take the initiative, with or without the help of others, to diagnose their learning needs, formulate learning goals, identify resources for learning, select and implement learning strategies, and evaluate learning outcomes (Knowles 1975).

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Adult Learning

Adult learning differs from children’s learning in several important respects. In our context, it is clear that registrar training should be firmly based on the principles of adult learning. This is true too in many respects of our undergraduate students in their clinical years, though there are aspects in which the younger age and lesser maturity of these students require a different approach.

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Teaching Methodology

Active Learning

Adapted from Lara V.,
McKinney K,

Surprisingly active learning in fact refers more to a style of teaching than of learning.

The characteristics of active learning techniques are that students do more than simply listen to a lecture. Students are DOING something including discovering, processing, and applying information. Research shows greater learning when students engage in active learning.

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